A 17-year-old assault victim who refuses parental involvement
A 17-year-old boy attends alone at 8 pm after being punched at a party. He has an uncomplicated crown fracture of 11 and 21 with exposed dentine, a 1.5 cm lip laceration, and no loss of consciousness. He is alert, fluent, and understands the treatment options. He refuses consent for you to contact his parents and asks you not to tell anyone what happened. He says he does not want the police involved. He has no relevant medical history and is not under the influence of alcohol or drugs. The practice is about to close; you have composite, glass ionomer, local anaesthetic, and suturing materials available. You are unsure whether you can treat him without a parent present and whether the assault must be reported.
1. Can you treat this patient without parental consent? Explain your reasoning.
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Yes, provided he has capacity to consent. In Ireland, a person aged 16 or over may consent to dental treatment, so parental consent is not legally required for a 17-year-old. Capacity means he can understand the nature and consequences of the treatment, retain the information, weigh it, and communicate a choice. He appears to meet that threshold: he is alert, fluent, and understands the options.
I would still assess for coercion or vulnerability. Ask whether he feels safe, whether anyone is pressuring him, and whether he has somewhere to go afterwards. If there are concerns about capacity, coercion, or immediate safety, treat urgent problems and seek senior or child-protection advice. Record the capacity assessment and the fact that he consented himself. Do not let the late hour push you into skipping that documentation.
2. How should you handle confidentiality and the disclosure of assault?
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Start from confidentiality: he is entitled to expect that his information is not shared without consent. Explain the limits of confidentiality in plain terms, including the possibility of disclosure where there is a risk to him or others, or a child-protection concern.
A single peer assault is not automatically a child-protection report. I would encourage him to report it to An Garda Síochána and offer support, but I would not promise to keep a serious safety risk secret. If there are signs of abuse, coercion, exploitation, or ongoing danger, follow Children First and consult the practice's designated liaison person or Tusla. Document his refusal to involve the police or parents, the advice given, and the reasons for any disclosure. The key judgement is distinguishing confidentiality from a genuine child-protection duty.
3. What records and follow-up would you arrange?
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Record the history, the assault detail in his own words, capacity assessment, consent, and the discussion about confidentiality and reporting. Record the clinical findings, including pulp sensibility, mobility, percussion, and lip wound. If you take photographs, obtain specific consent and store them securely.
Treatment can include local anaesthesia, composite restoration or glass ionomer coverage of the fractured dentine, and suturing of the lip. Warn him about pulpitis, pulp necrosis, discolouration, and the need for review. Arrange review at about 1 week for the lip and 6–8 weeks for pulp sensibility. Give written aftercare advice and an emergency contact. If he later agrees, encourage him to involve his GP or a trusted adult; do not contact them behind his back.